[A Case of Descending Colon Cancer Resulting in Cecal Perforation and Necrosis of the Large Intestine Due to Obstructive Colitis].

Abstract

An 81-year-old woman had been constipated for a week and experienced nausea and decreased appetite 3 days earlier. She developed chills and general fatigue and was referred to our department. A plain abdominal computed tomography (CT)scan showed wall thickening of the descending colon, the oral side of the intestine was significantly dilated and filled with fecal masses, the anal side of the intestine was collapsed, and ascites and free air were present. Emergency surgery was performed. The area from the cecum to the descending colon was markedly dilated, and a tumor was identified in the descending colon. Fecal fluid leaked from 2 locations on the anterior wall of the cecum, and the walls from the cecum to the ascending colon were poorly colored and necrotic. The necrotic intestine was resected, and an ileostomy and transverse colon mucous fistula were constructed. Radical surgery was performed 26 days after the surgery. Invasion of the transverse colon by descending colon cancer was suspected; therefore, we performed resection from the transverse colon to the sigmoid colon, D3 dissection, and transverse colon-sigmoid colon anastomosis. After adjuvant chemotherapy, the ileostomy and mucous fistula were closed. Nearly 3 years have passed since the radical surgery, and the patient is currently under follow-up with no recurrence.